Department of Psychiatry and Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea.
Prog Neuropsychopharmacol Biol Psychiatry. 2009 Nov 13;33(8):1409-16. doi: 10.1016/j.pnpbp.2009.07.019. Epub 2009 Jul 24.
Social cognition entails both cognitive and affective processing, and impairments in both have accounted for residual symptoms of bipolar disorder (BD). However, there has been a lack of studies identifying neural substrates responsible for social cognitive difficulties in BD patients. Fourteen euthymic BD patients and 14 healthy normal controls underwent functional MRI while performing a virtual reality social cognition task, which incorporated both cognitive and emotional dimensions, simulating real-world social situations. During the scanning, subjects tried to guess (attribute) possible reasons for expressed emotion of virtual humans (avatars) while viewing their facial expressions, just after observing their verbal and nonverbal (facial) expressions which were emotionally valenced (happy, angry and neutral). BD patients compared to normal controls showed delayed reaction times in emotional conditions, with comparable response accuracy. Healthy normal controls activated the right anterior cingulate cortex, inferior frontal, and insular cortex in emotional conditions contrasted with neutral control conditions, that is, the regions that have been related to empathic processes during viewing others' emotional expression. Relative to normal controls, BD patients showed reduced activations in the 'mirror neuron system', including the right inferior frontal cortex, premotor cortex, and insula, mainly in angry or happy condition. These results may suggest that, even during euthymic state, BD patients have difficulties in recruiting brain regions for the utilization of emotional cues as a means for understanding others. Clinical attention should be paid to emotion-related residual symptoms to help improve social outcomes in these patients.
社会认知既需要认知加工,也需要情感加工,而这两者的损伤都可以解释双相情感障碍(BD)的残留症状。然而,目前还缺乏研究来确定导致 BD 患者社会认知困难的神经基础。14 名病情稳定的 BD 患者和 14 名健康正常对照者在执行虚拟现实社会认知任务时接受了功能磁共振成像,该任务结合了认知和情感维度,模拟了现实世界中的社交情境。在扫描过程中,受试者在观看虚拟人类(化身)的面部表情后,试图猜测(归因)他们表达情绪的可能原因,而此前他们刚刚观察了这些化身的言语和非言语(面部)表情,这些表情是有情绪色彩的(高兴、生气和中性)。与正常对照组相比,BD 患者在情绪条件下的反应时间较慢,但反应准确性相当。健康的正常对照组在情绪条件下激活了右侧前扣带皮层、下额前回和脑岛,而在中性控制条件下则没有激活,这表明这些区域与在观看他人情绪表达时的共情过程有关。与正常对照组相比,BD 患者在“镜像神经元系统”中的激活减少,包括右侧额下回、运动前皮层和脑岛,主要是在生气或高兴的情况下。这些结果可能表明,即使在病情稳定的情况下,BD 患者在利用情绪线索理解他人方面也存在大脑区域招募困难。临床应注意与情绪相关的残留症状,以帮助改善这些患者的社交结局。